Adjuncts to bowel management for fecal incontinence and constipation, the role of surgery; appendicostomy, cecostomy, neoappendicostomy, and colonic resection

Semin Pediatr Surg. 2020 Dec;29(6):150998. doi: 10.1016/j.sempedsurg.2020.150998.Epub 2020 Nov 20.

Devin R Halleran 1, Cornelius E J Sloots 2, Megan K Fuller 3, Karen Diefenbach 4


Author information

  • 1Department of Surgery, Upstate Medical University, Syracuse, NY, United States. Electronic address: devinrhalleran@gmail.com.
  • 2Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
  • 3Department of Surgery, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States.
  • 4Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States.


Constipation and fecal incontinence are common problems in children after repair of an anorectal malformation (ARM). While many children can be effectively managed with an oral laxative regimen, others require a mechanical colonic washout to achieve social continence. Appendicostomy and cecostomy are two techniques which permit antegrade access to the colon for the purpose of enema delivery, which improves compliance and quality of life for patients and families. The purpose of this article is to review, using a case-based approach, the indications for placement of a channel for antegrade enema access, clinical scenarios in which one technique would be preferred over another, common complications following each procedure.

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